Provider Demographics
NPI:1598129546
Name:EDMONDS, JOHN THOMAS (CRNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MILL CREEK XING
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7200
Mailing Address - Country:US
Mailing Address - Phone:334-713-9138
Mailing Address - Fax:
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE NUMBER 500
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-2799
Practice Address - Fax:256-265-8920
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner